Provider Demographics
NPI:1346210531
Name:HUGHES, MICHAEL K (O D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:HUGHES
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 E BOXELDER RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5582
Mailing Address - Country:US
Mailing Address - Phone:307-682-2747
Mailing Address - Fax:307-686-9984
Practice Address - Street 1:1103 E. BOXELDER RD.
Practice Address - Street 2:SUITE F
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5582
Practice Address - Country:US
Practice Address - Phone:307-682-2747
Practice Address - Fax:307-686-9984
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY129 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW22043OtherMEDICARE BUSINESS PTAN
WY115074000Medicaid
WY1346210531OtherINDIVIDUAL NPI
WY1447406269OtherBUSINESS NPI
WYW22044OtherMEDICARE INDIVIDUAL PTAN
WY115074000Medicaid
WY1346210531OtherINDIVIDUAL NPI